A new study conducted by researchers at Brigham and Women’s Hospital, in collaboration with Harvard T.H. Chan School of Public Health and the Brown School of Public Health, reveals a significant shift in the treatment of obesity. The study, published in JAMA Network Open, found that the use of anti-obesity drugs such as Ozempic and Wegovy has more than doubled between 2022 and 2023, while there was a corresponding 25.6 percent decrease in the number of patients undergoing metabolic bariatric surgery for obesity during the same period.
The researchers analyzed a national sample of over 17 million privately insured adults, focusing on those diagnosed with obesity without diabetes. Their findings highlight a marked increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a class of drugs that includes popular medications like Ozempic and Wegovy. From the last six months of 2022 to the last six months of 2023, the use of these drugs surged by 132.6 percent, from 1.89 to 4.41 patients per 1,000 insured adults. Conversely, the number of patients undergoing bariatric surgery dropped by 25.6 percent, from 0.22 to 0.16 patients per 1,000 adults.
While the study found that most patients—94.7 percent—did not receive either treatment, with only 5 percent prescribed GLP-1 RAs and 0.3 percent undergoing surgery, it indicates a shift in treatment preferences. Patients who opted for surgery tended to have more complex medical conditions compared to those who chose GLP-1 RA treatment.
Thomas C. Tsai, a senior author of the study and a metabolic bariatric surgeon at Brigham and Women’s Hospital, noted that this is one of the first national studies to quantify the decline in bariatric surgery usage alongside the rise of GLP-1 RA medications. He pointed out that while GLP-1 RAs have shown effectiveness in managing obesity and related conditions like diabetes, they have limitations, including high costs, limited availability, and gastrointestinal side effects that may lead some patients to discontinue treatment and experience weight regain.
“Metabolic bariatric surgery remains the most effective and durable treatment for obesity for now. National efforts should focus on improving access to both pharmacologic and surgical treatments to ensure patients receive the optimal care they need,” said Tsai. He also emphasized the need for further research to assess the long-term impact of this shift from surgical intervention to pharmacologic treatment on patient outcomes.
The rising popularity of GLP-1 RAs presents both opportunities and challenges. On the one hand, these medications offer a non-invasive treatment option for obesity. On the other hand, Tsai expressed concern that as more patients turn to these drugs, the utilization of bariatric surgery might continue to decline, potentially leading to the closure of bariatric surgery programs and reduced access to comprehensive obesity treatments, which often combine pharmacologic, endoscopic, and surgical approaches.
Co-author Ateev Mehrotra, chair of the Department of Health Services, Policy and Practice at Brown University, echoed these concerns, noting that despite the effectiveness of both GLP-1 RAs and bariatric surgery, fewer than 6 percent of patients in the study received either form of treatment. This statistic underscores a significant opportunity to expand the uptake of both surgical and pharmacologic treatments for obesity and related conditions.
The authors of the study urged clinicians and policymakers to closely monitor access to effective obesity treatments, as the landscape continues to evolve. They also called for additional research to understand the trade-offs between surgical interventions and the increasingly popular GLP-1 RA medications in the management of obesity. As more patients opt for pharmacologic treatments, it is crucial to ensure that both options remain available and accessible to all those in need of care.
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